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Occupational therapy
Occupational Therapy, often abbreviated as "OT", incorporates meaningful and purposeful occupation to enable people with limitations or impairments to participate in everyday life. Occupational therapists work with individuals, families, groups and populations to facilitate health and well-being through engagement or re-engagement in occupation. Occupational therapists are becoming increasingly involved in addressing the impact of social and environmental factors that contribute to exclusion and occupational deprivation.Occupational Deprivation: Global Challenge in the New Millennium, Whiteford (2000), British Journal of Occupational Therapy Volume 63, Number 5, pp. 200-204(5) The World Federation of Occupational Therapistsdefines occupational therapy as a profession concerned with promoting health and well-being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by enabling people to do things that will enhance their ability to participate or by modifying the environment, or the activity to better support participation.http://www.wfot.org/information.asp Another way of thinking about the ideas contained in these definitions could be: occupational therapy is about understanding the importance of an activity to an individual, being able to analyze the physical, mental and social components of the activity and then adapting the activity, the environment and/or the person to enable them to resume the activity. In other words, occupational therapists would ask, "Why does this person have difficulties managing his or her daily activities (or occupations), and what can we adapt to make it possible for him or her to manage better and how will this then impact his or her health and well-being?” Occupational therapy gives people the "skills for the job of living" necessary for "living life to its fullest."AOTA http://www.aota.org The College of Occupational Therapists (2004) describes OT as follows: Occupational Therapy enables people to achieve health, well-being and life satisfaction through participation in occupation. Occupational Therapy draws from the field of occupational science to provide an evidence base to practice and develop academic and practice links to other related disciplines such as social science and anthropology, and also utilises a range of generic models to guide the practice of OT. Occupation, occupational form and occupational performance Occupation Occupation is the dynamic relationship between the occupational form and occupational performance.Nelson, D., L. (1988)Occupation: Form and Performance. American Journal of Occupational Therapy. 42 (10) pp, 633-641Nelson, D., L. (1996) Therapeutic Occupation: A Definition. American Journal of Occupational Therapy. 50 (10), pp. 775-782 Many people see the term occupation as a job one does. However, the meaning of occupation is seen in a much wider context by an Occupational Therapist. A human being can be engaged in a wide range of occupations: leisure, self-care or educational activities are just a few examples of occupation.Richards, S. (2003) Occupational Therapy: Comment. The Independent Occupational Form Wu and Lin (1999) stated that the occupational form was the “...objective pre-existing structure or environmental context that elicits or guides subsequent human performance”. The occupational form consists of objective features. These may include materials, human context and socio-cultural dimensions.Wu, C and Lin, K. (1999) Defining Occupation: A Comparative Analysis. Journal of Occupational Science. 6 (1), pp. 5-12 Occupational therapy process An Occupational Therapist works systematically through a sequence of actions known as the occupational therapy process. There are several versions of this process as described by numerous writers. Creek (2003)Creek 2003 Occupational Therapy Defined as a Complex Intervention, London COT has sought to provide a comprehensive version based on extensive research. This version has 11 stages, which for the experienced therapist may not be linear in nature. The stages are: * Referral * Information gathering * Initial assessment * Needs identification/problem formation * Goal setting * Action planning * Action * Ongoing assessment and revision of action * Outcome and outcome measurement * End of intervention or discharge * Review Areas of practice in occupational therapy There are many areas of practice in occupational therapy which have often been divided into Physical Health and Mental Health. The division is not so clear as occupational therapists consider the physical, mental and social well-being of all clients in every setting. These divisions occur when the setting is defined by the population it serves for example acute physical or mental health settings (e.g.: hospitals), sub-acute settings (e.g.: aged care facilities), outpatient clinics and community settings. Physical health * Pediatrics - Schools, Community, inpatient hospital based childrens OT * Acute care hospitals * Inpatient rehabilitation (e.g., Spinal Cord Injuries) * Rehabilitation centres (e.g., TBI, Stroke (CVA), Spinal Cord Injuries, Head Injuries) * Skilled nursing facilities * Home Health * Outpatient clinics (e.g., Hand Therapy, orthopaedics) * Specialist assessment centres (e.g., Electronic assistive technology, Posture and Mobility services) * Hospices Mental health * Mental health inpatient units **Adolescent, adult and older people's acute mental health wards **Adult and older people's rehabilitation wards **Prisons/secure units (Forensic psychiatry) **Psychiatric intensive care unit **Specialist units for Eating Disorders, Learning disabilities * Community based mental health teams **Child and adolescent mental health teams **Adult and older people's community mental health teams **Rehabilitation and recovery and Assertive Outreach community teams **Primary care services in GP practices **Home treatment teams **Early Intervention for Psychosis services **Specialist learning disability, eating disorder community services **Day services **Vocational Services Vocational Rehabilitation Community Community based practice involves working with people in their own environment rather than in a hospital setting. It can also involve working with atypical populations such as the homeless or at-risk populations. Examples of community-based practice settings: * Health promotion and lifestyle change * Intermediate care services * Day centres * Schools * Child development centres * People's own homes, carrying out therapy and providing equipment and adaptations * Workplaces * Homeless Shelters * Educational Settings * Refugee CampsOccupation for Occupational Therapists, Matthew Molineux, Blackwell Publishing, 2004 Occupational therapy approaches Services typically include: * Teaching new ways of approaching tasksThe Independent Thursday 26th June 2003 Comment * How to break down activities into achievable components eg sequencing a complex task like cooking a complex meal * Comprehensive home and job site evaluations with adaptation recommendations. * Performance skills assessments and treatment. * Adaptive equipment recommendations and usage training. * Environmental adaptation including provision of equipment or designing adaptations to remove obstacles or make them manageable * Guidance to family members and caregivers.American Occupational Therapy Association, Inc. (2005). The use of creative media as therapeutic activity Activity analysis Activity analysis has been defined as a process of dissecting an activity into its component parts and task sequence in order to identify its inherent properties and the skills required for its performance, thus allowing the therapist to evaluate its therapeutic potentialCreek 2003 Occupational Therapy defined as a complex intervention. London. COT Therapeutic activity Occupational therapists use therapeutic activity or therapeutic occupation to improve an individual's occupational performance and increase function in activities of daily living (ADLs) and self care skills. A core and unique feature of occupational therapy practice is the use of occupation as a therapeutic mediumGolledge, J. (1998) Distinguishing between Occupation, Purposeful Activity and Activity, Part 2: Why is the Distinction Important? British Journal of Occupational Therapy, 61(4), pp.157-160.. An occupational therapy core skill as defined by The College of Occupational Therapists (COT) is the use of activity as a therapeutic toolCOT (2006) COT/BAOT Briefings: Definitions and Core Skills for Occupational Therapists. London: College of Occupational Therapists.. Occupational therapists have utilized activities, such as crafts, since the profession was foundedGriffiths, S. and Corr, S. (2007) The Use of Creative Activities with People with Mental Health Problems: a Survey of Occupational Therapists. British Journal of Occupational Therapy, 70(3), pp.107-114.. The arts and crafts movement in the very early 20th century had ascertained that goal directed activity had a curative effect on the social problems inherent in the newly industrialized societies. The founders of the occupational therapy profession extended this thinking to the treatment of individuals' with mental health problems and as a consequence between 1920 and 1940 much of occupational therapy practice concentrated around the use of crafts as purposeful activitiesTaylor, E. and Manguno, J. (1990) Use of Treatment Activities in Occupational Therapy. American Journal of Occupational Therapy, 45(4), pp.317-322.. The emergence of occupational therapy in physical medicine began during World War II and craft activities were utilised to rehabilitate injured soldiersTurner, A., Foster, M. and Johnson, S.E. (1997) Occupational Therapy and Physical Dysfunction: Principles, Skills and Practice. Edinburgh: Churchill Livingstone.. This method of practice was later termed by MoseyMosey, A.C. (1985) Psychosocial Components of Occupational Therapy. New York: Raven Press. as activity synthesis. Activity synthesis or occupational synthesis is the core of occupational therapy practice; occupational therapists, in collaboration with clients, design occupational forms to produce a therapeutic occupation or activity, that is meaningful and purposeful to the clientNelson, D. (1996) Therapeutic Occupation: A Definition. American Journal of Occupational Therapy, 50(10), pp.775-782.. The therapeutic activity or occupation may be used to assess the client’s occupational needs or to achieve a therapeutic goal. The component parts of an activity or occupation are matched with the required occupational performance outcomes. For example, the muscle movements elicited by pottery may address fine motor and gross motor skills to improve shoulder flexion and extension, range of movement and elbow extension and flexion.Tubbs, C. and Drake, M. (2007) Crafts and Creative Media in Therapy. 3rd ed. Thorofare: Slack Incorporated.. Other therapeutic activities or occupations may include cookery activities, such as making a smoothie or a healthy soup. The components of this activity such as planning and following a recipe may address cognitive components of occupational performance such as problem solving, sequencing and learning. Health may be promoted through this occupation, enabling clients to consider healthy eating issuesCOT (2008) Health promotion in occupational therapy. London: College of Occupational Therapists.. Occupational therapists may further use therapeutic activities or occupations to assess occupational performance. For example, an occupational therapist may ask a client to make a cup of tea or prepare a simple meal to assess performance in activities of daily living (ADLs). An occupational therapist may use a board or card game to assess cognitive components of occupational performance. This application of therapeutic activity/occupation involves use of the core skills of the occupational therapist, chiefly assessment and problem solvingCreek, J. (2003) Occupational therapy defined as a complex intervention. London: College of Occupational Therapists.. Theoretical Frameworks Occupational Therapists use a number of theoretical frameworks to frame their practice. Note that terminology has differed between scholars. Theoretical bases for framing a human and their occupation being include the following: Frames of Reference/Generic models Frames of reference or generic models are the overarching title given to a collation of compatible knowledge, research and theories that form conceptual practiceFoster, M. (2002) "Theoretical Frameworks", In: Occupational Therapy and Physical Dysfunction, Eds. Turner, Foster & Johnson.. More generally they can be defined as "those aspects which influence our perceptions, decisions and practice"Rogers JC (1983), Eleanor Clarke Slagle Lecture. Clinical Reasoning; the ethics, science and art. American Journal of Occupational Therapy, 37(9):601-616. Frames of reference have generally been a precursor to the design of theoretical models of practice. As such, through the development of such models, different terminology exists to define different frames of reference. Some broad terms as defined by FosterFoster, M. (2002), Theoretical Frameworks, in Occupational Therapy and Physical Dysfunction. Churchill Livingstone include: Developmental, Biomechanical, Learning and Compensatory. Approaches/Intervention models These are the methods of carrying out the Frames of Reference. Again, terminology differs depending on your viewpoint and literature base. Using the above author (), approaches can include the Adaptive (based on the compensatory Frame of Reference), Models Theories Evolution of the philosophy of occupational therapy The philosophy of occupational therapy has evolved over the history of the profession. The philosophy articulated by the founders that have owed much to the ideals of romanticismHocking, C (2004). Making a difference: The romance of occupational therapy. South African Journal of Occupational Therapy, 34(2), 3-5. , pragmatismBreines, E (1990). Genesis of occupation: A philosophical model for therapy and theory. Australian Occupational Therapy Journal, 37(1), 45-49. and humanism which are collectively considered the fundamental ideologies of the past century McColl, M A, Law, M., Stewart D., Doubt, L., Pollack, N and Krupa, T (2003). Theoretical basis of occupational therapy (2nd Ed). New Jersey, SLACK Incorporated. Chapparo, C. and Ranka. J. (2000). Clinical reasoning in occupational therapy in Higgs J and Jones M (2000) Clinical reasoning in the health professions. 2nd ed. Oxford, Butterworth Heinemann Ltd. Yerxa, E J (1983). Audacious values: the energy source for occupational therapy practice in G. Kielhofner (1983) Health though occupation: Theory and practice in occupational therapy. Philadelphia, FA Davis. . William Rush Dunton, the creator of the National Society for the Promotion of Occupational Therapy, now the American Occupational Therapy Association, sought to promote the ideas that occupation is a basic human need, and that occupation was therapeutic. From his statements, came some of the basic assumptions of occupational therapy, which include: * Occupation has an effect on health and well-being. * Occupation creates structure and organizes time. * Occupation brings meaning to life, culturally and personally. * Occupations are individual. People value different occupationsTownsend, Elizabeth A. and Helene J Polatajko. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-Being & Justice Through Occupation. Ottawa: CAOT Publications ACE.. These have been elaborated over time to form the values which underpin the Codes of Ethics issued by each national association. However, the relevance of occupation to health and well-being remains the central theme. Influenced by criticism from medicine and the multitude of physical disabilities resulting from World War II , occupational therapy adopted a more reductionistic philosophy for a time. While this approach lead to developments in technical knowledge about occupational performance, clinicians became increasingly disillusioned and re-considered these beliefs Turner, A. (2002). History and Philosophy of Occupational Therapy in Turner, A., Foster, M. and Johnson, S. (eds) Occupational Therapy and Physical Dysfunction, Principles, Skills and Practice. 5th Edition. Edinburgh, Churchill Livingstone, 3-24.. Punwar, A.J. (1994). Philosophy of Occupational Therapy in Occupational Therapy, Principles and practice. 2nd Ed. Williams and Wilkins, Baltimore, 7-20.. As a result, client centeredness and occupation are re-emerging as dominant themes in the profession, perhaps indicating growing maturity and self confidence Douglas, F M (2004). Occupational still matters: A tribute to a pioneer. British Journal of Occupational Therapy, 67(6), 239. Whiteford, G. and Fossey, E. (2002). Occupation: The essential nexus between philosophy, theory and practice. Australian Occupational Therapy Journal, 49(1), 1-2. Polatajko, H (2001). The evolution of our occupational perspective: The journey from diversion through therapeutic use to enablement. Canadian Journal of Occupational Therapy, 68(4), 203-207. . Over the past century, the underlying philosophy of occupational therapy has evolved from being a diversion from illness, to treatment, to enablement through meaningful occupation. This became evident through the development and widespread adoption of the Canadian Model of Occupational Performance. The two most commonly mentioned values are that occupation is essential for health and the concept of holism. However, there have been some dissenting voices. Mocellin in particular advocated abandoning the notion of health through occupation as obsolete in the modern world and questioned the appropriateness of advocating holism when practice rarely supports it Mocellin, G. (1988). A perspective on the principles and practice of occupational therapy. Generally they need to eat loads of bananas and chocolate. British Journal of Occupational Therapy, 51(1), 4-7. Mocellin, G. (1995). Occupational therapy: A critical overview, Part 1. British Journal of Occupational Therapy, 58(12), 502-506. Mocellin, G. (1996). Occupational therapy: A critical overview, Part 2. British Journal of Occupational Therapy, 59(1), 11-16. . The values formulated by the American Association of Occupational Therapists have also been critiqued as being therapist centred and not reflecting the modern reality of multicultural practice Kielhofner, G. (1997). Conceptual Foundations of Occupational Therapy. 2nd Ed. Philadelphia, F.A.Davis. Hocking, C and Whiteford, G (1995). Multiculturalism in occupational therapy: A time for reflection on core values. Australian Occupational Therapy Journal, 42(4), 172-175. . Central to the philosophy of occupational therapy is the concept of occupational performance. In considering occupational performance the therapist must consider the many factors which comprise overall performance. This concept is made more tangible using models such as the person-environment-occupation model proposed by Law et al. (1996)The Person-Environment-Occupation Model, Law et al (1996), Canadian Journal of Occupational Therapy, vol 63 n1 p9-23 Apr 1996. This approach highlights the importance of satisfactions in one's occupations, broadening the aim of occupational therapy beyond the mere completion of tasks to the holistic achievement of personal wellbeing. In recent times occupational therapists have challenged themselves to think more broadly about the potential scope of the profession, and expanded it to include working with groups experiencing occupational deprivation which stems from sources other than disabilityOccupational Therapy without borders:learning from the spirit of survivors, Kronenburg et al, Churchill Livingstone 2004. Examples of new and emerging practice areas would include therapists working with refugees, and with people experiencing homelessnessThe Process and Outcomes of a Multimethod needs assessment at a homeless shelter, Finlayson et et al (2002), American Journal of Occupational Therapy Challenges for Occupational Therapy A key challenge for occupational therapy is to develop and maintain a definition of it's nature and scope. Cara and MacRae (2002) Psychosocial Occupational Therapy, Cara and MacRae (2002), Thompson Delmar assert that whilst this presets a challenge, it also results in a unique flexibility which allows the discipline to move with the flow of social, cultural and environmental change. This difficulty in definition may be a cause of chronic strain for practitioners Occupational Therapy in Community Mental Health Teams: a Continuing Dilemma? Role Theory offers an Explanation, Hughes (2001), British Journal of Occupational Therapy, Volume 64, Number 1,pp. 34-40(7) and may also contribute to a lack of role definition and subsequent blurring Role overlap between occupational therapy and physiotherapy during in-patient stroke rehabilitation: an exploratory study, Booth and Hewison (2002) Journal of Interprofessional Care. Recent literature has also called for Occupational Therapy to address the political nature of who we are and what we do (Kronenberg and Pollard 2005). The World Federation of Occupational Therapists TheWorld Federation of Occupational Therapists (WFOT) is the key international representative for Occupational Therapists and Occupational Therapy around the world and the official international organisation for the promotion of Occupational Therapy. Founded in 1952, WFOT currently has 66 member associations. Click on the link below to WFOT member nations to find specific information about each country’s history, occupational therapy education system, registration requirements and relevant organizations. Occupational Therapy Associations * World Federation of Occupational Therapists * The American Occupational Therapy Association * Australian Association of Occupational Therapists * British Association/College of Occupational Therapists * Canadian Association of Occupational Therapists Occupational Therapy Education * The European Network of Occupational Therapy in Higher Education Licensing and Registration requirements * Occupational Therapy License Information * Health Professions Council, UK * Kids Health for Parents - Occupational Therapy Association * US Department of Labor - Occupational Outlook Handbook - 2008, 2009 edition * US Army Medical Specialist Corps, Occupational Therapist (65A) Se also *Physical therapy References *Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 Edition, Occupational Therapists, on the Internet at http://www.bls.gov/oco/ocos078.htm (visited July 11, 2008). #Baum C., & Christiansen, C., (1997), The occupational therapy context: Philosophy - Principles - Practice. In C. Christiansen & C. Baum (Eds.), Occupational Therapy: Enabling Function and Well Being. p. 36. Thorofare, NJ: SLACK #Bing, R.K. (1981) Occupational therapy revisited: A paraphrastic journey. American Journal of Occupational Therapy, 35(8):499-518. #Low, J. (1992). The reconstruction aides. American Journal of Occupational Therapy. Jan;46(1):38-43, #Meyer, A. (1922). The philosophy of occupation therapy. Archives of Occupational Therapy, 1, 1-10. Buchanan, M. (1941). "letter " Journal of Occupational Therapy 3(2): 12. Hobcroft, N. (1949). "Life in the Occupational Therapy Department at Porirua." New Zealand Occupational therapy Newsletter Number Two. (May). New Zealand Occupational Therapy Registration Board (1950). "Minutes of the New Zealand Occupational Therapy Registration Board." 20th June. New Zealand Occupational Therapy Registration Board (1970b 17th July). "Minutes of the New Zealand Occupational Therapy Registration Board." New Zealand Registered Occupational Therapists Association (1949). "AGM Minutes." NZJOT (1996). New Zealand Journal of Occupational Therapy 47(1): 19. NZNJ (1940). "Editorial " New Zealand Nursing Journal 33(11): 346. Packer, T., & Stickney, Jan (1991). "Advanced Diploma in Occupational Therapy: A comparison of therapists before and after." Journal of New Zealand Association of Occupational Therapists Inc. 42(1): 3-7. Skilton, H. (1981). Work for your life - the story of the beginning and early years of occupational therapy in New Zealand. Hamilton, Hudlo Printers. Wilson, L. H. (2004). Role differentiation in a professionalising occupation: the case of occupational therapy, New Zealand Department of Management Dunedin University of Otago PhD. ---- Category:Occupational therapy O Category:Rehabilitation medicine Category:Therapy